SAM CASE STUDY ASSIGNMENT 1
Sam Case Study Assignment
Megan Grubbs
School of Behavioral Sciences, Liberty University
Case Study Assignment Sam
Sam is a 25-year-old Caucasian female who has decided to seek counseling due to her
manic episodes, mood swings, hallucinations, depressive episodes, and suicidal ideations. She
currently is pursuing her master’s degree in social work at the local university but is failing now.
The symptoms listed have been present in Sams life on and off for two years now and she has
decided to pursue counseling.
Client Concerns
Biological factors
Psychological
Social/cultural
Spiritual
Physical symptoms, for Ideas, thoughts Family systems, Religious and spiritual
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example: neurological,
past present impact
Past and present
feelings, beliefs,
values about self,
others the world
Past and present
Relationships with
others,
Cultural elements
Past, present
aspects of self/family
Past present
Manic Episodes Decrease in sleep, failing
classes, isolation
Strained relationship with
roommates, failing out of
program, lying
Mood Swings Decrease in sleep,
hopelessness
Strained relationship with
roommates and
friends
Depressive Episodes Excess sleep, failing classes Suicidal tendencies, socially
isolating
Stopped attending Mass when
she started her masters
Hallucinations Decrease in sleep, not eating Strained relationship with
friends, mood swings, failing
school
Suicidal Ideation Missing follow up
appointment with
psychologist
Strained relationship with
roommates
Wants to integrate
religious views into
counseling
Assessment
After reviewing Sam’s symptoms, I have decided to use the Mood Disorder
Questionnaire (MDQ). This is a self-report assessment that will be split into a three-part
questionnaire. Within the first part the client will be asked to give 13 statements regarding
manic and hypomanic symptoms, the second part will consider the timer period in which the
symptoms occurred, and the third part will measure the impairment these symptoms have had
on their functionable life. This assessment has been shown to have the ability to decipher the
difference between Borderline Personality Disorder and Bipolar Disorder (Balling et al., 2019).
This seemed like a perfect fit for Sam because the test aligns with her symptoms and is split into
a three-part self-assessment.
Diagnostic Impression
When reviewing Sam’s case, she mentioned having symptoms such as depressive
episodes and manic episodes which leads to my primary diagnosis of Bipolar I Disorder, current
major depression episode, severe, which is ICD-10 diagnostic code F31.4. This was my initial
diagnosis due to her frequent moderate and major depressive episodes and manic episodes.
These episodes are not due to any substance abuse or other medical condition. She has
experienced large mood swings and energy swifts that ranged for longer than seven days, which
SAM CASE STUDY ASSIGNMENT 3
was also a major consideration when making this diagnosis. My secondary diagnosis would be
Major Depressive Disorder which is coded F33.2, which was indicated by her frequent
depressive episodes but were ruled out by her manic episodes which led this diagnosis to not
meeting the criteria.
Signs and Symptoms
DSM-5-TR Diagnostic Criteria: Bipolar I Disorder
– Code: F31.4
Client’s Signs/Reported Symptoms from case
study:
Criterion A: Manic Episodes- A distinct period
of abnormally and persistently elevated,
expansive, or irritable mood and abnormally
and persistently increased goal-directed activity
or energy, lasting at least 1 week and present
most of the day, nearly every day
Sam reported that the first manic episode she
had was ten days long in which she reported
being very productive. She didn’t need much
sleep during this time. Her most recent episode
lasted for twelve days.
Criterion B: Inflated self-esteem Sam believed that she was the best Author to
live and stayed up most days and nights trying
to finish her book. She expressed this to her
roommate as well. The sleep deprivation
caused her to hallucinate which then caused a
break
down.
Criterion C: Depressive Episode- symptoms
cased a large impairment on her social,
occupational, or important focuses in life
Sam has seen impacts in her job, graduate
program, and interpersonal relationships. She
has gone to the extent of lying to her
professors and avoiding telling her mother and
sister what is going on.
Criterion D: Recurrent thoughts of death,
suicidal ideation without a plan, a specific plan,
or attempt
Sam has recently been researching ways that
would be pain free to commit suicide. After her
roommate found out is when she demanded
that she get help or she would move out.
Other DSM-5-TR Conditions Considered
While reading into Sam’s case I was able to notice other DSM-5-TR symptoms but as I
gained more information about her past, I was able to rule them out because she didn’t meet
the necessary criteria. I had noted Bipolar II Disorder coded at F31.81 because of her constant
SAM CASE STUDY ASSIGNMENT 4
depressive episodes over the last two years. However, she did not meet the standards because
she has experienced two manic episodes in the past which does not fit the criteria.
Developmental Theories and/or Systemic Factors
Sam best identifies with Erik Erikson’s sixth stage, “Intimacy vs. Isolation”. She is trying to
salvage the last relationship she still has, her roommates. Those with Bipolar Disorder struggle
to keep and maintain relationships because of the symptoms and episodes that they go through.
For example, Sam has come to the idea of counseling due to her roommate becoming upset and
threatening to leave. She also noted that she hasn’t had any romantic relationships since she
began her graduate program two years ago which is when these symptoms really set in. These
issues combined could be contributing to Sams symptoms of depression because she is simply
just lonely. This developmental stage ranges from 19-40, as Sam mentioned wanted to get
married and start a family, she may feel a sense of pressure or isolation which is a aspect of the
stage of “Intimacy vs. Isolation”.
Multicultural Competencies and Considerations
Sam is a Caucasian female who is Catholic but reports that she stopped attending Mass
when she began her graduate program two years ago. Familywise, Sam mentions that her
parents got divorced when she was 14 and since then her relationship with her brother and
father has been scarce. She has continued to talk to her mother and sister once every week. Her
mother has a background with depression and was the reason for her parents’ divorce.
Recently, Sam has also been failing out of her graduate program and refuses to admit her
struggles when confronted by her professors. After reviewing Sam’s case and the cultural
influences she’s had, I view her as being ashamed and hopeless with her mental health
struggles, which is why she has avoided treatment for two years now.
Treatment Recommendations
SAM CASE STUDY ASSIGNMENT 5
Key Issues for Treatment
After reviewing and understanding Sam’s case I have found two symptoms that need to be
addressed first and below I will list them by importance:
•Suicidal Ideation- The client needs immediate intervention to address past and present
suicidal thoughts.
•Manic Episodes- The client has been experiencing manic and depressive episodes which
cause large mood swings, insomnia, and hallucinations.
Recommendations for Counseling
With consideration of Sam’s recent suicidal tendencies, I would initially recommend
Cognitive Behavioral Therapy (CBT) due to its goal of altering maladaptive thought patterns,
equip her with better problem-solving skills, and regulate emotions. I would first address how
Sam is coping with these manic and depressive episodes, further discussing how she has
resulted in looking at ways that would be the “least painful” to end her life. After doing research
and considering Sam’s past, I’ve found that CBT is best for those who are Bipolar because it has
proven effective in relapse prevention (Ye et al., 2016). Not only will this help prevent relapse
but will give Sam the resources she needs to avoid her triggers, spiral thinking, and manic
thoughts.
My second recommendation for Sam would be Functional Family Therapy (FFT). FFT is an
evidence-based intervention to help adults and children with bipolar disorder regain and regrow
interpersonal relationships. Not only would this give the client coping skills, but it also provides
the families with ways in which they can help support the client through their healing process
(Miklowitz & Chung, 2016).
In regards to medication, I would highly recommend Sam begin taking a mood stabilizer.
After researching, I have found that mood stabilizers have shown to decrease the mortality rate
of those with bipolar disorder and help them create a more regulated routine (Lin et al., 2023).
It is so important that when choosing a specific medication for a client we also consider what
treatment therapy the counselor is using to ensure that they align.
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Specific Considerations
Sam is currently in a crisis situation of having suicidal ideations, to the extent of
researching ways in which to do it. This severely changes the initial focus for her counseling
from her assessment or treatment plan to a safety plan for her. As her counselor I would address
the current crisis situation by beginning with coping skills, gather all mental health background,
and address the symptoms based off of severity. After addressing this concern, it could alter the
diagnosis because of the high emotional state, hopelessness, and manic state that Sam is in.
After the initial crisis is handled then we would move on with our treatment plan. After
reviewing
Sam’s case and researching different assessments, I have found that the Suicide Ideation and
Behavior Assessment Tool (SIBAT) is a constant measure both patient-rated and clinician-rated
components that has been designed to systematically and comprehensively measure rapid
changes in suicidal ideation and behavioral (Alphs et al., 2020). As Sam’s counselor this will help
me keep these suicidal ideations in check as we move on to her true assessment and treatment.
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References
Alphs, L., Fu, D.-J., Williamson, D., Turkoz, I., Jamieson, C., Revicki, D., & Canuso, C. M.
(2020). Clinicalkey. ClinicalKey. https://www.clinicalkey.com/#!/content/1-s2.0-
S0165178120331565
Balling, C., Chelminski, I., Dalrymple, K., & Zimmerman, M. (2018, November 22). Differentiating
borderline personality from bipolar disorder with the mood disorder questionnaire
(MDQ): A replication and extension of the International Mood Network
(IMN) Nosology Project. Comprehensive Psychiatry.
https://www.sciencedirect.com/science/article/pii/S0010440X18301949
Lin, C., Yeh, L., & Pan, Y. (2023). Degree of exposure to psychotropic medications and mortality
in people with bipolar disorder. Acta Psychiatrica Scandinavica, 147(2), 186–
197. https://doi.org/10.1111/acps.13509
Miklowitz, D. J., & Chung, B. (2016). Family-Focused Therapy for Bipolar Disorder:
Reflections on 30 Years of Research. Family Process, 55(3), 483–499.
https://doi.org/10.1111/famp.12237
Ye, B.-Y., Jiang, Z.-Y., Li, X., Cao, B., Cao, L.-P., Lin, Y., Xu, G.-Y. and Miao, G.-D. (2016),
Effectiveness of cognitive behavioral therapy in treating bipolar disorder: An updated
meta-analysis with randomized controlled trials. Psychiatry Clin. Neurosci., 70: 351361.
https://doi.org/10.1111/pcn.12399
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